Electronic Reimbursement Vendors

What are Electronic Reimbursement Vendors?

Electronic Reimbursement Vendors (or electronic payment service companies) deliver claim payments on behalf of multiple payers to the healthcare provider. While some work with larger payers, there also are over 1,500 smaller healthcare payers in the United States, including third-party administrators (TPAs), Taft Hartley and regional health plans representing the self-insured market, which are reflective of 25-30% of the insured population.

These companies offer options for payments including electronic funds transfer (EFT) and electronic remittance advice (ERA, also sometimes known as “explanation of benefits”). Working with these companies can eliminate the time and trouble associated with directly signing up with large numbers of these individual payers, and provides a single source of contact to manage the payments and related data.

Why are Electronic Reimbursement Vendors now included in EnrollHub?

Not every payer currently participates in EnrollHub, particularly the many hundreds of smaller healthcare payers. In order to facilitate electronic payments and remittance advice for more healthcare providers from more payers, CAQH decided to include Electronic Reimbursement Vendors within EnrollHub, and make participation in these services easier by enabling sign up through our EFT/ERA enrollment solution. In this way, more healthcare practices can convert from vendor payment by paper checks and virtual cards to EFT and ERA.

How is using EnrollHub to sign up for Electronic Reimbursement Vendors different than signing up for EFT and ERA directly with health plans participating in EnrollHub?

Some elements are the same. EnrollHub enables your practice to submit your practice and banking information into your secure EnrollHub account, so there is no need to re-enter this information. If you select the vendor as an option in EnrollHub, your information is then shared with the electronic reimbursement vendors currently reimbursing your practice by check or virtual payment card. However, your practice will need to also speak directly with a representative from the electronic payment service company to begin using their services.

I don’t currently receive any payment checks from any of the Electronic Reimbursement Vendors listed, so why should I sign up for their services?

In most cases, Electronic Reimbursement Vendor payments are made on behalf of, and in the name of, the actual payer. If your healthcare practice received an email or other communication from EnrollHub listing the name of an Electronic Reimbursement Vendor, then it has been identified as currently receiving payments – either by check or virtual card – from such a vendor. Converting those payments into EFT/ERA through the vendor can save your practice time and trouble.

If I sign up for an Electronic Reimbursement Vendor through EnrollHub, does that mean I am automatically enrolled with the company?

No. As with all participating EnrollHub payers, each electronic reimbursement vendor must decide if a specific healthcare provider practice is currently receiving payments by paper check or virtual card from their company, and therefore eligible to enroll with EFT and ERA with their company. Additionally, an Electronic Reimbursement Vendor works with each practice to help them determine if their services are right for that practice before finalizing enrollment. After you select the electronic reimbursement vendor(s) in EnrollHub, they will contact you to further discuss those details. Or, you may contact them directly at the phone number(s) listed below.

How does CAQH choose which Electronic Reimbursement Vendor participate in EnrollHub?

With a goal of streamlining provider enrollment in EFT/ERA throughout the healthcare industry, CAQH welcomes the participation of Electronic Reimbursement Vendors in EnrollHub, and does not grant exclusive participation rights to any single organization.

Which Electronic Reimbursement Vendors currently participate in EnrollHub?

Zelis™ Payments (formerly Pay-Plus® Solutions).
Call them directly at 855.496.1571 for more information about their services.